Decontamination
Reducing the NHS’s impact on the environment
Paul Chivers, an independent consultant, highlights the latest research which suggests that a new decontamination technology has the potential to “save thousands of Tonnes of CO2, and the equivalent of 115 swimming pools of water per year”.
Extraordinary times call for extraordinary measures and COVID-19 proved to be a driver for innovative research into the decontamination of medical equipment and personal protective equipment (PPE). My previous role was the head of the PPE Reuse, Innovation and Sustainability team, at the Department of Health and Social Care and NHS Supply Chain, during the pandemic, and we were tasked with testing and exploring potential for reprocessing of PPE. This was prompted by concerns over shortages, but was also against a backdrop of increasing awareness of the impact on the environment, caused by the huge amounts of waste from PPE, and waste due to out of date PPE. When the government funding for the Reuse,
Innovation and Sustainability project came to an end, as the country came out of lockdown and returned to some normality, I sought to continue the work - while shortages of disposable PPE were no longer an issue, the environmental problem caused by its use had not gone away. PPE and respiratory protective equipment (RPE) have multiplied in demand in healthcare applications ever since the pandemic emerged in March 2020. In fact, it is estimated that NHS and social care segments spent roughly £500 million on disposable RPE in 2020. Disposable RPE creates a major environmental challenge, with each item containing significant amounts of single-use and non-recyclable plastic materials. Each disposable mask - regardless of whether it is tight fitting or loose fitting - has to be discarded as infectious waste requiring incineration. Until now, the healthcare industry has lacked practical processes to effectively decontaminate items in between use. While disposable masks have a significant negative impact on the environment, ensuring the safest possible standards for patients remains the priority for health staff. And so it should. Any solution that provides reusable equipment
would require an evidenced decontamination process as well as complete traceability of that process. It would need to be able to eliminate any level of scepticism surrounding the ability
Figure 1. The carbon footprint of PPE has been calculated to total over 100,000 tonnes CO2e
to disinfect items to a safe level. Funding and investment into new technology that facilitates that has always presented an obstacle. However, reliable, sustainable solutions are now possible, and those fears can be alleviated.
Reusable respirators and masks It is not just PPE that is of concern. Other single use items are having a major impact on our planet, prompting research into whether reusable alternatives could be safely and easily decontaminated. This led me to managing a study, with Northampton General Hospital and Mackwell Health, on the implementation of a new process to reprocess reusable anaesthetic masks. The technology, which uses UV-C, was tested in a UKAS accredited test laboratory. A two-stage process was developed:
1. A manual cleaning step includes the use of a hypochlorous disinfectant and Decitex microfibre cloth. The solution is effective immediately, 300 times more effective than bleach and is effective against C.diff. Five sprays of the hypochlorous disinfectant are required and the microfibre cloth is then used to wipe the reusable anaesthetic mask.
2. The mask is placed in a UV-C cabinet, the start button is pressed, and the machine runs silently for 20 minutes. It will hold six anaesthetic masks in total.
The UV-C cabinet, part of Mackwell Health’s ‘Whitebox’ range, was first tested to meet the requirements of the new UV-C high level disinfection standard BS8628:2022. This was achieved in January of this year. A real-world simulation study on the disinfection of re-usable anaesthetic masks then achieved a >6 Log reduction of Geobacillus stearothermophilus spores in artificial saliva. The use of the UV-C cabinet avoids the need
to use a washer disinfector or autoclave to decontaminate the masks. The study calculates that this could achieve significant savings in water (94%-98% reduction), a reduction in power (>99%) and a >99% reduction in CO2e (See Figure 2) You would need to run the UV-C cabinet 400 times before you get anywhere near the same power consumption that a washer disinfector uses on one cycle. Trial data which demonstrate the financial and CO2e savings for the UV-C cabinet are also shown in Figure 3.
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